OP0201-PARE DEVELOPMENT THROUGH CO-CREATION OF A PERSONALIZED, MULTIMODAL, PHYSIOTHERAPIST-LED, WORK-ORIENTED INTERVENTION TO INCREASE WORK ABILITY IN WORKING PEOPLE WITH RHEUMATOID ARTHRITIS OR AXIAL SPONDYLOARTHRITIS.
Authors: N. Bakker, J. Knoop, N. Hutting, Y. Heerkens, J. Engels, J. B. Staal, M. van der Leeden, A. Boonen, J. Tiggeloven, N. Schuur, T. P. M. Vliet Vlieland, S. van Weely
Journal: Annals of the Rheumatic Diseases (2022)

Background Although work ability is considered a key element of quality of life for working people, work is underexposed in current treatment in people with rheumatoid arthritis (RA) or axial spondyloarthritis (axSpA). Most people with RA or axSpA attend a physiotherapist (PT). Physiotherapy can effectively improve physical fitness, which is associated with work ability. Therefore, PTs might play an important role in optimizing work ability of people with RA or axSpA. Objectives Developing a personalized, multimodal, PT-led, work-oriented intervention for working people with RA or axSpA who have a reduced work ability, through a co-creation process. Methods A systematic co-creation process with all relevant stakeholders was conducted following the Medical Research Council (MRC)-framework for complex interventions (see Figure 1). In step 1, all relevant clinical guidelines and treatment protocols were assessed. Based on the results of this assessment, a draft version of the intervention was developed, consisting of mandatory (i.e., work-oriented intake, patient education, exercise therapy, referral-roadmap of work-related professionals) and optional treatment modalities (i.e., workplace-intervention, self-management course). In step 2, focus groups with people with RA/axSpA, PTs and occupational/rheumatology experts were organized and qualitatively analysed. In the focus groups, barriers and facilitators of work-oriented treatments and necessary adaptations to the draft intervention were discussed. In step 3, a pre-test was performed to test the feasibility of the intervention in a primary physiotherapy setting, which was evaluated in the group of PTs participating in the pre-test in step 4. Finally, in step 5, a final focus group with researchers in this field was held to discuss the findings from previous steps in this co-creation process and to agree on necessary adaptations in the final intervention. Figure 1. Process of systematic development of co-created, work-oriented physiotherapist-led intervention following the MRC-framework. Results After developing the draft intervention, we conducted two focus groups with people with RA/axSpA (n=16; 4 with RA, 12 with axSpA), one focus group with PTs (n=12) and one focus group with occupational/rheumatology experts (n=9; 2 rheumatologists, 2 nurse specialists, 1 physiatrists, 1 physician assistant, 1 nurse practitioner, 1 labour expert and 1 occupational therapist). People with RA or axSpA emphasized 3 aspects: i) PTs should have adequate expertise in RA/axSpA, ii) high potential for a role of ‘buddy’ by PTs to support them in work-related problems, and iii) most PTs currently lack adequate expertise on work-related problems. PTs and experts underlined the importance of extensive training of PTs on work-related laws and regulations and adequate (work-related) interprofessional collaboration. After revision of the draft intervention, the intervention was tested for feasibility by three PTs and three working people (2 with RA, 1 with axSpA), who indicated that the intervention was feasible and that the developed intervention facilitated PTs to support people in optimizing their work ability. However, adequate training on providing this intervention was recognized to be essential. In a final focus group with researchers (n=6), consensus was reached on minor adjustments to the intervention that were based on findings from previous steps. Conclusion Through a systematic co-creation process based on the MRC-framework, we have been able to develop a personalized, multimodal, PT-led, work-oriented intervention for working people with RA or axSpA and a reduced work ability. The (cost-)effectiveness of this intervention is currently being tested in a large trial (Physiotherapy WORKs study). Acknowledgements This study is funded by the Dutch Arthritis Society (ReumaNederland) and the Scientific College of Physical Therapy (WCF) of the Royal Dutch Society for Physical Therapy (KNGF). This study is registered in the Netherlands Trial Register under number NL9343. Disclosure of Interests None declared